Crohn's disease changes over time and your treatment may need to be adjusted to stay ahead of the condition. Learn when to talk to your doctor about your treatment plan.

Crohn’s disease can change and
progress over time, and to feel your best, your treatment plan may have to
change with it. Knowing when it’s time to adjust your Crohn’s treatment can
help you stay symptom-free longer and prevent complications from the condition.

Although there’s no cure for
Crohn’s disease, effective treatments are available to suppress symptoms, allow
your intestines to heal, and induce and maintain remission.

Treatment options for Crohn’s
disease are determined by the severity and duration of the condition. They may
include drugs, diet modification, nutritional supplementation, surgery, or a
combination of these approaches. As changes occur in the state of your
condition, you’ll likely have different combinations of these treatment options
as part of your Crohn’s treatment plan.

When to Call Your Doctor About Your Treatment

Determining when it’s time to
adjust your Crohn’s disease treatment is simple, says Themos Dassopoulos, MD, an
associate professor of medicine in the division of gastroenterology and the director
of the inflammatory bowel diseases program at Washington University in St.
Louis. You should change your treatment plan whenever a treatment isn’t working
or when the side effects can’t be managed, such as an allergy, infection, or
severe nausea, Dr. Dassopoulos explains.

If you experience a side effect
from a Crohn’s disease drug, inform your doctor immediately. Don't stop taking
any medication without first discussing it with your doctor. Starting and
stopping certain drugs used to treat Crohn’s disease on your own can cause them
to lose their effectiveness.

The biggest warning sign that
it’s time to adjust your Crohn’s disease treatment is if familiar symptoms come
back — that is, symptoms you previously experienced during a flare. A
return of Crohn's disease symptoms may be the signal that your current Crohn's disease
medication is losing its effectiveness. The dose or frequency of dosing may
need to be adjusted to improve symptom control.

Other common symptoms of
Crohn’s disease to watch for include:

Diarrhea

Rectal bleeding

Abdominal pain,
often in the lower right area

Low-grade fever

Weight loss

Dassopoulos says even if your
Crohn’s disease is under control, experiencing these symptoms may indicate that
you have a complication that needs medical attention, such as an obstruction in
your bowel or an abscess in your abdomen.

How Your Crohn’s Disease Treatment May Progress

Mild Crohn's disease symptoms
may be initially treated with aminosalicylate or antibiotic drugs to help decrease
inflammation in the colon and gastrointestinal tract.

Moderate cases of Crohn’s
disease may be treated with corticosteroids, immunomodulators, biologics, or a
combination of these drugs. Each of these drugs work in different ways to
target the inflammation associated with Crohn’s disease.

Corticosteroids may be given
for a short period to treat a flare and bring you to remission. Corticosteroids
work quickly, but they suppress the entire immune system and have significant
side effects, so they're not intended as a long-term treatment option.

The other two types of
medications, immunomodulators and biologics, can help reach and maintain
remission. Immunomodulators work by modulating or suppressing the body’s immune
system so it can’t cause inflammation. Biologic drugs are the newest class of
drugs used to treat Crohn’s disease. They target specific proteins in the body
associated with the immune system’s inflammatory response. Both of these
therapies are considered maintenance therapies, meaning treatment is continued
once you are in remission to keep you there.

“For people
with severe Crohn’s disease, biologic drugs are needed,” Dassopoulos says. “The
question then is whether to use biologics alone or to also add immunomodulators,
which may help with the tapering-off effect of biologics.”

Although most
people with moderate to severe Crohn’s disease initially respond to biologics,
the response can decrease over time. If a biologic is no longer effective,
switching to a different biologic may be an option.

Despite the best medication and
treatment, up to 75 percent of people with Crohn’s disease will need surgery
for severe complications over the course of their lifetime, typically when
medications no longer work to control symptoms, or if you develop a fistula,
fissure, or intestinal obstruction.

Dassopoulos says that most
people with Crohn’s disease try at least two or three different drugs over the
course of their disease. Often, he says, the biggest decision in adjusting Crohn’s
disease treatment is whether to use biologics or immunomodulators or both.

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